HEALTHY EATING: Diet may offer key to fighting osteoporosis

Dietitians look at overall diet quality first to assess ways to increase nutrients beneficial to bone as well as food sources of calcium, preferred over supplements.

By Joan EndykeFor The Patriot Ledger

Today, sophisticated medical equipment can detect osteopenia, the first sign of osteoporosis, yet simple follow-up care known to prevent progression to debilitating osteoporosis – like the type of calcium to take, dosing and diet changes – is often lacking and is an example of a fractured medical system in need of repair.

Pat was diagnosed with osteopenia five years ago and started taking a calcium supplement when advised by her doctor, in addition to choosing calcium-fortified foods. For years, she took 600 mg of calcium carbonate (Caltrate) with a glass of orange juice fortified with calcium (300 mg,) a multivitamin (200 mg), and Multigrain Cheerios with milk (400 mg) at breakfast time. Unbeknownst to Pat the body can only absorb roughly 500 mg of calcium at one time; the rest was not helping her bones but was being eliminated in urine.

Pat did not consume significant sources of calcium later in the day and it wasn’t until she saw a registered dietitian for a different medical concern that she became aware of this dietary problem.

Osteoporosis can cost billions in healthcare dollars for medical services related to hip and spine fractures, rehabilitation care and medications. A quick check of diet and supplements from a registered dietitian can reduce this risk and should be part of the treatment plan.

Dietitians look at overall diet quality first to assess ways to increase nutrients beneficial to bone as well as food sources of calcium, preferred over supplements. Aim for three good sources, providing 25 to 30 percent of the daily value on a food label (250-300 mg) spread throughout the day. This could include orange juice fortified with calcium at breakfast, milk at lunchtime, and yogurt for snacks. The daily value is set at 1,000 mg per day to accommodate the needs of the general population but be aware women over 51 years old and men over 71 should be aiming higher, 1,200 mg daily.

Make careful food selections. For example Greek yogurt is higher in protein but tends to have 50 percent less calcium than standard yogurts and foods like broccoli (40 mg per cup,) Kale (100 mg per cup,) cottage cheese (typically less than 100 mg per cup,) and almonds (60 mg per quarter cup) are low sources. For those with lactose intolerance, Lactaid milk (or lactase pills), soy or almond milk or orange juice fortified with calcium could be options.

If a calcium supplement is warranted, buy one with vitamin D for best absorption. The two major types are calcium carbonate (Caltrate, Tums, Viactiv and others) and calcium citrate (Citracal.) Carbonate forms should be taken with food for adequate stomach acid for absorption but Citrate can be taken anytime. Check the serving size on the label to determine the amount of calcium per pill. If two servings are needed, space them out in the day.

It’s not all about calcium either. New research finds too many grains, like breads, cereals, muffins, crackers, bagels, cookies, and the like increase blood acidity that causes calcium to leach out of bones to neutralize it. Fruits and vegetables do the opposite; they assist in neutralizing acid and provide magnesium an essential bone nutrient. Produce with the highest acid-neutralizing ability are raisins, apricots, kiwi fruit, watermelon, pear, orange, apple, pineapple, strawberries, pears, spinach, zucchini, carrot, tomato, cauliflower, lettuce, green beans, broccoli and asparagus.

To protect your bones eat generous portions of fruits and vegetables, get enough calcium and vitamin D, and cut back on grain foods.

Joan Endyke is a registered dietitian with a master's degree in food and nutrition. Send your questions to her at www.wickedgoodhealth.com. This column is not intended to diagnose or treat disease. Check with your doctor before changing your diet.